By Steve Schulte of
Health Advocate Solutions
In the disorienting mixture of headiness and distraction that naturally follows the House's historic passage of healthcare reform over the weekend, it's important to get perspective---fast. That is why former President Bill Clinton is going to speak with Democratic senators.
Without some perspective, clarity and new urgency it's not at all clear that healthcare reform will pass the Senate this year. Or, if it does, that it will be---in the quaint phrasing of that politician of an earlier time–John Nance Garner–worth a bucket of warm spit.
This country needs far-reaching reform. Polls show us demanding such reform by wide margins. But, under the surface, there is also anxiety about cost and the rising deficit, distrust of government, derision of politicians. And, more disturbingly, there are orchestrated and highly financed efforts that are working tirelessly to make sure that any reform is either stopped outright or arrives stillborn. This fight is epic and no-holds barred.
What's at stake is the first time in 40 years (since Medicare passed after strenuous political maneurvering---sound familiar?) that a similar major healthcare overhaul has been within sight. The passage of Part D (medication coverage) and Part C (urging seniors to choose managed care plans) do not count. They were minor skirmishes that resulted in victories for major healthcare industries. They were no "people's victories".
But for effective and far-reaching healthcare reform to pass some key myths must be confronted. Each of these myths obscures the goal---making quality, affordable healthcare accessible for all (or nearly all) Americans. These myths arise from the American psyche of distrust in government. They also arise, fullblown, from the anxieties of status quo healthcare players who sense the landscape may be shifting. In any case, these myths need to be confronted directly and overcome. Then healthcare reform may be able, finally, to emerge.
Myth #1: Reform must be incremental. What is being considered now is too big, too costly. Well, this one is ideological. Yes, there is a huge deficit looming. We need to deal with that. But why must healthcare access and reform be sacrificed for this battle? Why not military contracting? Why not tax relief for wealthy Americans? Why not giant farm subsidies? The list goes on. Just one example serves here. At the beginning of THIS century we could have spent $800 billion on healthcare reform. Instead, we chose tax relief for the wealthiest Americans. That battle still rages.
Myth #2: A strong government option will be inefficient and it will drive private insurers from the "free" market. To get a handle on this one needs to remember two things: the government is ALREADY in healthcare. CMS (which runs Medicare and Medicaid) covers about 92 million citizens who get their healthcare through Medicare and Medicaid. That does not count the Veterans Administration and its huge healthcare empire.
Some grumbling, sure. But when was the last time you heard someone wanting to turn in their Medicare benefits? Or turn down Medicare? Second,do you really believe private insurers are lining up to cover single mothers, people with severe pre-existing conditions, the frail elderly? That's why the government needs to get involved here. Now. To set standards and to ensure the "weak and needy" get covered as well. The market will NOT do that alone or without motivation.
Myth #3: Medicare will suffer under reform because, in order to fund the new legislation, billions will have to be drained from Medicare thus draining current coverage. Nonsense. Reform will cost somewhere near $1 trillion over ten years. BUT only about a third of that will come from Medicare. How? Interesting question. Right now (because of Part C...) managed care companies---who market Medicare Advantage plans---are subsidized by the federal government to entice them to ensure elderly Americans. Each individual plan is subsidized to about 15% of the total annual premium. Why is this necessary or fair? Can't these companies compete? If we cut only this portion that would scoop up at least $100 billion to help pay for reform. The rest of the Medicare savings would come from new efficiencies in delivery and hospitalization. Why, to take one example, does it cost more to treat a Medicare patient in Los Angeles than in Hawaii? (Don't say "the weather"...)
Myth #4: Private insurers and hospitals don't have the margin needed to cover the uninsured and those with pre-existing conditions. They will go broke. Really? And yet they are getting--by mandate---up to 50 million new customers? Sounds pretty phony. Further, insurance companies set premiums in part by what is called a loss-ratio. That tells them how much of their total premium they might have to pay out for care in any given year. An 85% loss ratio, for example, would allow a full 15% of total premium dollars to be used for marketing (expensive...), salaries, administration and so on. VERY FEW private insures have an 85% loss ratio. Many are from 65% and up. They are not only NOT in trouble. They are highly profitable, ineffiecient and unethical. Let the government set a target loss ratio and have them learn to compete. Some of US have managed to survive so far without adequate coverage....
Myth #5: This is moving too fast; it would be better to wait, figure this out, take smaller bites. To us humans change always feels slightly giddy. Unnerving. Disorienting. Political change is not that different. (A black president???)But change always happens fast. It's always rude and sudden, sometimes it upends our sense of equilibrium. Once we have adjusted we do just fine.
In addition, healthcare reform can't be done incrementally. Everyone must be in or there will not be the best economic efficiencies. Everyone must be able to get coverage or the insurers will continue to "cherry pick" the healthiest to cover. One big, simultanious effort is needed to reform this broken, inefficient, unfair system.
Enough studies. Enough committees. We may not have all the answers, we no doubt will have to make changes and adjustments down the road. But we DO know what's needed. Let's move on that and trust our best instincts. And, yes, do what' right. We know how to do that, too.
Myth #6: The President and the Congress need to make major concessions to conservative Democrats and Republicans so "we can get something". That's "the change we can believe in"? Remember, the Democrats helped to elect many of those conservatives. And, truth be told, is this about the next election or the next majority or about the welfare of American citizens?
Sorry for the strong rhetoric, but ask yourself: will this opportunity, if lost, come back again in 10 years? 15? 20? One more thing. To get these votes we have to set back abortion rights for perhaps 15 years? Whether for or against abortion, are you in favor of it being available only to the well-off and tony? Take us back to the Fifties?
Lastly: do you really think that Lieberman, Nelson (NE), Cantor, Boehner, McConnell, Bailey-Hutchinson...and on and on will vote for ANY significant reform? Remember,this is not just about policy and sick old people and the deficit. It's about ideology. About business as usual. About privilege.
So how badly do YOU want reform? Let you elected representatives hear from you today.
To respond to this blog, email steve6schul@yahoo.com
No comments:
Post a Comment